外周血T淋巴细胞亚群联合自然杀伤细胞在梅毒血清固定中的预测价值  

Predictive Value of Peripheral Blood T Lymphocyte Subsets Combined with Natural Killer Cells in Serum Fixation of Syphilis

作　　者：郝丽莎 周向昭[1] 朱由瑾 HAO Lisha;ZHOU Xiangzhao;ZHU Youjin(Department of Dermatology,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院皮肤科,河北张家口075000

出　　处：《医学综述》2023年第8期1635-1639,共5页Medical Recapitulate

基　　金：河北省政府资助临床医学优秀人才培养项目(冀卫办科教〔2021〕1号)。

摘　　要：目的分析外周血T淋巴细胞亚群联合自然杀伤细胞(NK细胞)在梅毒血清固定中的预测价值。方法选取2017年4月至2019年4月河北北方学院附属第一医院收治的202例梅毒患者作为研究对象,经正规治疗且临床症状、体征消退(临床治愈)后,一期梅毒随访12个月、二期梅毒随访24个月、三期梅毒随访36个月,将连续3个月以上快速血浆反应素环状卡片试验及甲苯胺红不加热血清试验非梅毒螺旋体抗体滴度维持在一定水平的患者作为血清固定组,余非梅毒螺旋体抗体滴度转阴患者作为非血清固定组。比较两组患者外周血T淋巴细胞与NK细胞水平,分析外周血T淋巴细胞亚群及NK细胞与梅毒血清固定的相关性及其在梅毒血清固定中的预测价值。结果202例梅毒患者经正规治疗且临床治愈后随访1~3年,失访8例,余194例患者中有56例患者出现血清固定,138例患者非梅毒螺旋体抗体滴度转阴。两组患者梅毒分期分布比较差异有统计学意义(P<0.05),两组性别、年龄比较差异无统计学意义(P>0.05)。临床治愈后,血清固定组患者辅助性CD4^(+)、辅助性CD4^(+)/抑制性CD8^(+)、NK细胞水平明显低于非血清固定组[(33.80±4.65)%比(40.79±4.68)%、1.24±0.26比1.67±0.29、(12.50±3.72)%比(14.68±3.94)%](P<0.01),抑制性CD8^(+)细胞水平明显高于非血清固定组[(30.86±4.40)%比(25.69±4.39)%](P<0.01)。Pearson相关性分析结果显示,辅助性CD4^(+)、辅助性CD4^(+)/抑制性CD8^(+)、NK细胞水平与血清固定呈显著负相关(r=-0.563,P<0.001;r=-0.575,P<0.001;r=-0.248,P<0.001),抑制性CD8^(+)细胞水平与血清固定呈显著正相关(r=0.472,P<0.001);受试者工作特征曲线分析结果显示,外周血T淋巴细胞联合NK细胞水平预测梅毒血清固定的灵敏度为84.8%、特异度为76.9%。结论外周血T淋巴细胞联合NK细胞水平预测血清固定的灵敏度、特异度较高,能够为血清固定的临床防治提供参考。Objective To analyze the predictive value of T lymphocyte subsets combined with natural killer(NK)cells in serum fixation of syphilis.Methods A total of 202 patients with syphilis admitted to the First Affiliated Hospital of Hebei North University from Apr.2017 to Apr.2019 were included.After normal treatment and clinical symptoms and signs subsided(clinical cure),the patients were followed up for 12 months for primary syphilis,24 months for secondary syphilis and 36 months for tertiary syphilis.The patients with non-treponema pallidum antibody titers maintained at a certain level for more than 3 months in rapid plasma reagin ring card test and toluidine red unheated serum test were assigned to a serum-fixation group,and the patients with residual non-treponema pallidum antibody titers turned negative were assigned to a non-serum-fixation group.The levels of peripheral blood T lymphocytes and NK cells were compared between the two groups,and the correlation of peripheral blood T lymphocyte subsets and NK cells with syphilis serum fixation and their predictive value in syphilis serum fixation were analyzed.Results Among the 202 patients,8 patients were lost to follow-up,and 56 cases of the remaining 194 patients showed serum fixation,and 138 cases had negative titer of non-treponema pallidum antibody.There were statistically significant differences in the staging distribution of syphilis between the two groups(P<0.05),but no statistically significant differences in gender and age between the two groups(P>0.05).After clinical cure,the levels of auxiliary CD4^(+),auxiliary CD4^(+)/inhibitory CD8^(+)and NK cells in the serumfixation group were significantly lower than those in the non-serum-fixation group[(33.80±4.65)%vs(40.79±4.68)%,1.24±0.26 vs 1.67±0.29,(12.50±3.72)%vs(14.68±3.94)%](P<0.01),and the levels of inhibitory CD8^(+)cells were significantly higher than those in the non-serum-fixation group[(30.86±4.40)%vs(25.69±4.39)%](P<0.01).Pearson correlation analysis showed that the levels of auxiliary CD4^(

关 键 词：梅毒 T淋巴细胞亚群 自然杀伤细胞 血清固定 预测价值 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]